Provider Demographics
NPI:1598031643
Name:GERIATRIC MEDICINE CONSULTANTS PA
Entity Type:Organization
Organization Name:GERIATRIC MEDICINE CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-543-6165
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-5137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 BREIDABLIK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-1925
Practice Address - Country:US
Practice Address - Phone:302-543-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty